Understand 5 Ways for Health Insurance Claims

Health insurance is indeed considered to have several benefits, which is very helpful for us in doing treatment, especially those who need large costs such as surgery. Not a few of those who have difficulty finding funding for treatment at a high enough cost

Although there are many who currently have insurance, some of them even do not know or understand the procedure for claiming insurance. Although the procedure has been explained by the agent and written clearly in the policy book. For that we need to understand the ways and procedures to claim our insurance. Below are some ways you can follow to claim insurance.

  1. Make sure to always pay premiums

When we decide to have health insurance, it’s good to consider the premium to be paid each month. Make sure that our monthly income can be sufficient to pay for health insurance payments. Taking into account beforehand that we can pay the monthly premium and make it as a mandatory expenditure every month.

That way, make sure that our policy does not have a hole or forget to pay a monthly premium.

  1. Make sure the insurance period has been more than 30 days

Many insurance companies determine the insurance period after 30 days. For that reason, if it is less than 30 days, then if we are going to go to the hospital for treatment it is likely that it will not be accepted or rejected, except in urgent conditions such as an accident. So before we have to make sure that the active period or age of the policy is more than 30 days after applying for health insurance.

  1. Make sure to Read the Exclusion Clause

After we officially have health insurance and get a policy, there are several things that must be considered. For example, reading the policy in the exclusion clause.

The following are some examples of the contents of the exclusion clause which are stated in the policy.

  • For critical illnesses such as coronary heart disease and 34 other critical illnesses, it can only be claimed at least after 6 months. That way if we have had heart disease before we should not rush to claim it, try to wait 6 months to 1 new year we can claim.
  • For diseases that already existed before, whether we know it or not, the insurance company will not cover it. For example, for congenital diseases.

After that, make sure we check the insurance ceiling that has been provided for us. This ceiling contains the maximum medical costs that will be covered by insurance as long as we are treated. If you use more than the cost of care, then you have to pay back for the deficiency.

  1. What if we suddenly get sick?

If the insurance card has an international SOS number, then call to ask the nearest hospital that we can refer to.

After getting a hospital referral, usually the hospital will ask if the ward will be in accordance with the ceiling or higher. If we really can add to the shortcomings it doesn’t matter if you choose higher than our ceiling.

Generally, hospital insurance uses cards and with the card so we do inpatient treatment for free, aka not spending a single cent because everything is covered by insurance.

  1. Pay later (Reimbursement)

In health insurance, there is a reimbursement method or pay later. So when doing treatment, we have to pay for the medical expenses first, but the costs will be replaced at the end by the insurance. The following is the procedure for reimbursement.

In the reimbursement method, there are 2 types of forms of claims, namely the customer claim form against the insurance company, and the second form the certificate of the treating doctor

When going to the hospital, be sure to bring the two forms and give them to the nurse, then those who will fill in with the hospital stamp.

When finished, we will get a bill for treatment that we do from the hospital, make sure to copy the receipt and ask the hospital to legalize, because the original receipt will be requested by the insurance.

After returning from the hospital, we will have 3 documents, two claim forms and one receipt. After that, we can complete it with a photocopy of ID card and photocopy of the account book. The document is then provided in the section of the insurance claim department concerned. We can monitor the process by telephone and after a maximum of 14 days we will receive compensation money as stated in the receipt from the insurance.

Pay attention to the Claim Method

For some people, the steps above are still considered a little confusing. But be sure to re-understand it so that we get the benefits of the health insurance we have. In essence, whatever type of insurance you use, try to make sure by asking first about the insurance claim mechanism.

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